Today, I’d like to get back to basics. For me, Human Rights in Childbirth (HRiC) means that birthing women have the right to choose where, when, and with whom they will have their baby. I realized the other day that I’m writing with the assumption that my audience even knows that midwives exist, let alone the various types of midwives or the laws that apply to midwives. With this in mind, I am going back to the start and define/distinguish the various options that pregnant women have when considering with whom to give birth.
A pregnant woman in Oregon has several options for childbirth that the State recognizes as valid, legal options:
- A perinatologist handles high-risk pregnancies – they commonly work in clinics that are called something like, “Maternal Fetal Medicine”. They are highly prepared to intervene medically or surgically during pregnancy and birth. Some MFM clinics also care for women who are not high-risk and provide obstetric and nurse midwifery care under the same roof. These doctors only deliver in hospitals, typically in hospitals with appropriate NICU care for babies who need medical intervention to survive.
- A physician can do all your prenatal care, deliver your baby at the hospital, and follow up with postpartum care. The most common of these physicians is the obstetrician (the OB in OB/GYN), but some primary care physicians also offer obstetrical care to their patients. Another physician who delivers babies is the DO (Doctor of Osteopathy). Almost all doctors attend births in the hospital.
- A naturopath midwife (ND) – who is a naturopath with additional training in midwifery. Naturopathic midwives receive a doctoral degree from a four- year accredited naturopathic medical school. Additionally they complete didactic specialty training, as well as a preceptorship under a licensed naturopathic midwife, in the treatment and management of pregnancy and natural childbirth.
- A certified nurse midwife (CNM) – has a nursing degree and receives additional training in midwifery. CNMs are supervised by OB/GYNs and provide primarily hospital based services, though there are a handful of CNMs who also do home births. If you are talking about a midwife who practices in a hospital, it’s likely she is a certified nurse midwife, which is legal in every state.
- A direct-entry midwife (DEM) can actually be applied to several other types of midwives and is kind of a confusing term because it doesn’t offer enough detail. Often all the home birth midwives are lumped into this classification, but it is too simplistic and doesn’t offer any distinction between education and licensure status. A lot of home birth midwives consider themselves to be DEM. Often if you see LDEM as a credential, it means she is a licensed, direct-entry midwife, which is also the same as a CPM. Confused yet? That’s exactly part of the problem!! It gets confusing to talk about “midwives” when there are so many different types of midwives. Direct entry midwifery is not legal in every state. Licensure is not available for direct entry midwives in many states. Direct entry midwifery is a legal option in Oregon; both licensed and unlicensed direct entry midwives are legal options for birthing women in Oregon.
- A certified professional midwife (CPM) – has completed a midwifery program and/or an apprenticeship to qualify for the NARM exam and has passed the certification exam and met the requirements set forth by NARM for certification. In Oregon, all licensed home-birth midwives must be CPM midwives. The CPM credential does not equal licensure, but is required by most states that do offer a licensure program.
- A licensed midwife (in Oregon) is also a certified professional midwife, by default, because certification by NARM is a requirement for licensure. Licensure (in Oregon) currently requires a midwife to be certified in basic CPR and neonatal resuscitation, take an LD&D class (Legends, Drugs, and Devices) for certification in order to use a limited number of pharmaceuticals, such as Pitocin and Cytotec (anti-hemorrhagics) and also to administer an IV, catheter, and other procedures that are unique to licensed midwives. Licensure permits a CPM midwife to bill the Oregon Health Plan for midwifery care in certain circumstances. Licensed midwives adhere to a set of laws and rules that are determined through legislative processes and hearings. Licensed midwives are regulated through the Oregon Health Licensing Agency (OHLA). Complaints against licensed midwives are made to the OHLA board, are investigated by OHLA, and are disciplined through OHLA. For more information about licensed midwives in Oregon, you should visit the OHLA Direct Entry Midwifery Board website, where there is a ton of information, including a searchable license database. Not every state has a licensure program, which means home birth midwifery is still illegal with a CPM midwife in many states.
- An unlicensed midwife is often called a “lay midwife” or a “traditional midwife” and is a legal option for pregnant women (in Oregon). Though midwives with a CPM are eligible for licensure, some choose to remain unlicensed, while other unlicensed midwives may not have completed the requirements or the process for certification and are truly “lay midwives.” Some unlicensed midwives have comparable educational and experiential backgrounds as licensed and certified professional midwives. Lay midwives typically depend on natural methods and herbal remedies to manage complications at birth, as legal access to carry oxygen, pharmaceuticals, and to do certain procedures is only provided with licensure. I think it’s important for consumers (mothers) to understand that hiring an unlicensed also means that consumers (mothers) do not have a regulatory agency who will investigate a report should they choose to file a complaint. In some cases, unlicensed midwives have been investigated and subsequently disciplined through the criminal court system rather than through the licensing board, as the laws and regulations and appropriate disciplinary action of the licensing board would not apply to an unlicensed midwife.
- Just to be super clear, a doula isn’t a pregnancy or a birth care provider at all. Doulas provide emotional and educational support only – they do not do prenatal care, nor do they deliver (or catch) babies.
So the next time you see Ima Midwife, CPM, LDEM you will know that this is a certified professional midwife who is also a licensed direct entry midwife (a home birth midwife), and you may get to know my friend, Shesa Midwife, DEM, who is an unlicensed direct entry midwife, and if you run into Youra Midwife, CNM, you’ll know she’s most likely a hospital based certified nurse midwife.
What kind of a birth provider did you choose and why?